Diversity Monitoring Form

1. Gender Identity
Which of the following describes how you think of yourself?
MaleFemaleIn another wayPrefer not to say

Is the current gender you identity with different to the gender you were described as at birth?
YesNoPrefer not to say

2. Disability
Do you consider yourself to be a disabled person, e.g. experiencing barriers in society?
YesNoPrefer not to say

3. Ethnic background
White
UKIrishGypsy or TravellerAny other White background

Mixed/Multiple ethnic background
Mixed ethnic background

Asian/Asian UK
IndianPakistaniBangladeshiChinese

Any other Asian background

Black/African/Caribbean/Black UK
AfricanCaribbean

Any other Black/African/Caribbean background

Other ethnic group
ArabPrefer not to say

Any other ethnic group

4. Age
18-25 years26-40 years41-50 years51-65 years66-80 years81 plusPrefer not to say

5. Religion or belief
No religionChristianBuddhistHinduJewishMuslimSikhOtherPrefer not to say

6. Sexual orientation
HeterosexualLesbianGay manBisexualLGBTQ+Prefer not to say

7. Caring responsibilities
People with caring responsibilitiesPeople without caring responsibilitiesPrefer not to say